Search

INTRODUCTION: The COVID-19 pandemic led to a dramatic increase in telemedicine use for direct patient care. Inequities in device/internet access can limit the extent to which patients can engage with telemedicine care and exacerbate health disparities. In this review, we examined existing literature on interventions designed to improve patient telemedicine access by providing digital devices including tablets, smartphones, and computers and/or internet connectivity. METHODS: In this systematic scoping review, we searched four databases for peer-reviewed studies published 1/1/2000-10/19/2021 that described healthcare interventions that provided patients with devices and/or internet connectivity and reported outcomes related to telemedicine access and/or usage. Data extraction elements included: study population, setting, intervention design, details on device/connectivity provision, and outcomes evaluated. RESULTS: Twelve articles reflecting seven unique interventions met inclusion criteria. Ten articles examined telemedicine utilization (83%) and reported improved patient show rates/utilization. Seven articles examined patient satisfaction with the interventions (58%) and reported positive experiences. Fewer articles examined health outcomes (17%; 2/12) though these also demonstrated positive results. Across included studies, study quality was low. There were no controlled trials, and the most rigorously designed studies (n = 4) involved pre/post-intervention assessments. DISCUSSION: Findings from this review indicate that providing material technology supports to patients can facilitate telemedicine access, is acceptable to patients and clinicians, and can contribute to improved health outcomes. The low number and quality of existing studies limits the strength of this evidence. Future research should explore interventions that can increase equitable access to telemedicine services. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=183442, identifier, PROSPERO: CRD42020183442.

Abstract Antimicrobial resistance is a global threat, and pet-associated strains may pose a risk to human health. Equine veterinarians are at high risk of carrying methicillin-resistant staphylococci (MRS), but specific risk factors remain elusive, and few data are available for other personnel involved in the horse industry. The prevalence, characteristics, and risk factors for nasal carriage of MRS in horses and their caregivers were studied in northwestern Italy. Nasal swabs from 110 asymptomatic horses housed at 21 barns and 34 human caregivers were collected. Data on barns, horses, and personnel were acquired through questionnaires. The samples were incubated in selective media, and the bacterial isolates were identified by mass spectrometry. Risk factors were investigated by Poisson regression. MRS were isolated from 33 horses (30%), 11 humans (32.4%) and 3 environmental samples (14.2%). Most isolates were multidrug resistant (MDRS). The prevalence of MRS and MDRS was greater in racehorses and their personnel than in pleasurable and jumping/dressing horses. MRS carriage in caregivers was associated with an increased prevalence of MRS carriage in horses. The frequency of antimicrobial treatments administered in the barn during the last 12 months was a risk factor for MRS carriage in horses [prevalence ratio (PR) 3.97, 95% CI 1.11, 14.13] and caregivers (PR 2.00, 95% CI 1.05, 3.82), whereas a good ventilation index of the horse tabling environment was a protective factor (PR 0.43, 95% CI 0.20, 0.92). Our data reveal relevant interactions occurring between bacterial communities of horses and humans that share the same environment, suggesting that One Health surveillance programs should be implemented.

Creativity represents a young and promising academic field of research. Over the last 20 years, creativity publications have been steadily increasing in number. Of the 20 most all-time prolific creativity scholars in the European Union (EU), only one has retired. The present paper aims at mapping the EU creativity research. We analyzed over 12,000 Web of Science records dated back to 1968 until December 2020, using two bibliometric tools, SciMAT and VOSviewer. The descriptive analysis lists the most prolific authors and journals on the creativity area, the most cited articles, as well as the authors', institutions', countries', and research areas' bibliometric networks. Moreover, this study presents a thematic analysis and an evolution map of the themes based on keywords. The EU scholars were found to establish collaborations based on geographical, cultural, and, maybe, idiomatic proximity. Engineering, computer science, and education & educational research are the most interconnected areas of research. Innovation, performance, creative cities, the neuroscientific study of creativity, and emotions are relevant topics in the area. A broader concept of the creative and collaborative economy, the impact of technology on developing creativity, and the study of the brain with neuroscientific tools may become promising lines for future research.

Problem-solving competency is important not only in many careers but also in everyday life. Successful problem solvers regulate their cognitive processes and emotions. Our research aimed to study the impact of gamified problem sheets designed in Seppo on self-regulated learning skills. The intervention was carried out with second-year students in the specialization of Primary and Preschool Pedagogy. The research tool was a self-regulated problem-solving scale that was used as a pre- and posttest. In the experimental group, gamification lasted for 6 weeks. The game had 3 levels and the players could choose exercises from any level they wished. The results show that the gamified task sheet helped students to stay motivated and made problem-solving more enjoyable, but decreased some of their self-regulated processes, such as checking the correctness of the solution or searching for more solutions. This decrease could be explained by some psychological theories, the game elements, and the rules of the Seppo gamified problem sheets used in the intervention. On the basis of the conclusions, the role of some gamification aspects in developing different self-regulated processes can be identified, and the importance of a careful design of gamified problem sheets is highlighted.

Macro- and microscopic evaluation of feed includes detection of animal proteins, botanical ingredients and impurities, and prohibited ingredients such as packaging material (PM), according to Regulation (EC) 767/2009. In addition, detection of micro-plastics (possible degradation products of some of the PM) is getting attention. PM can harm animals or disturb their feed intake, pollute the environment, and are considered as undesired impurities in feeds. These materials do not consist of a definite molecule, group of molecules, living species or definite bodies. They can be plastic foil, hard plastic, metal pieces, paper, wood or some combination of materials. Their features (sharp, pointed) can be as important as the material itself. This is a typical topic for microscopy detection and evaluation. This short review presents the work done on detection of PM in 15 monitoring entities (institute, laboratories). Since 2011, some institutes have analysed more than 20 samples each year and the incidence of non-compliant samples will be presented here. Thirteen out of 15 entities have an active monitoring, whereas others have passive surveillance (done while performing other microscopy analyses). The protocols used by the different entities depend on sample types and analysts, highlighting a need for harmonisation.Highlights Former food products as ingredients for animal feed reduce food losses but contain residues of packaging material (PM). The microscopic examination and evaluation of feeds contribute to the safety of ingredients issued from food re-cycling and by-products valorisation. The lack of a prescribed method and limit of tolerance for PM cause variability in survey results.

Problem-solving competency is important not only in many careers but also in everyday life. Successful problem solvers regulate their cognitive processes and emotions. Our research aimed to study the impact of gamified problem sheets designed in Seppo on self-regulated learning skills. The intervention was carried out with second-year students in the specialization of Primary and Preschool Pedagogy. The research tool was a self-regulated problem-solving scale that was used as a pre- and posttest. In the experimental group, gamification lasted for 6 weeks. The game had 3 levels and the players could choose exercises from any level they wished. The results show that the gamified task sheet helped students to stay motivated and made problem-solving more enjoyable, but decreased some of their self-regulated processes, such as checking the correctness of the solution or searching for more solutions. This decrease could be explained by some psychological theories, the game elements, and the rules of the Seppo gamified problem sheets used in the intervention. On the basis of the conclusions, the role of some gamification aspects in developing different self-regulated processes can be identified, and the importance of a careful design of gamified problem sheets is highlighted.

OBJECTIVE: We applied natural language processing and inference methods to extract social determinants of health (SDoH) information from clinical notes of patients with chronic low back pain (cLBP) to enhance future analyses of the associations between SDoH disparities and cLBP outcomes. MATERIALS AND METHODS: Clinical notes for patients with cLBP were annotated for 7 SDoH domains, as well as depression, anxiety, and pain scores, resulting in 626 notes with at least one annotated entity for 364 patients. We used a 2-tier taxonomy with these 10 first-level classes (domains) and 52 second-level classes. We developed and validated named entity recognition (NER) systems based on both rule-based and machine learning approaches and validated an entailment model. RESULTS: Annotators achieved a high interrater agreement (Cohens kappa of 95.3% at document level). A rule-based system (cTAKES), RoBERTa NER, and a hybrid model (combining rules and logistic regression) achieved performance of F1 = 47.1%, 84.4%, and 80.3%, respectively, for first-level classes. DISCUSSION: While the hybrid model had a lower F1 performance, it matched or outperformed RoBERTa NER model in terms of recall and had lower computational requirements. Applying an untuned RoBERTa entailment model, we detected many challenging wordings missed by NER systems. Still, the entailment model may be sensitive to hypothesis wording. CONCLUSION: This study developed a corpus of annotated clinical notes covering a broad spectrum of SDoH classes. This corpus provides a basis for training machine learning models and serves as a benchmark for predictive models for NER for SDoH and knowledge extraction from clinical texts.

Mitochondria are essential regulators of cellular energy metabolism and play a crucial role in the maintenance and function of neuronal cells. Studies in the last decade have highlighted the importance of mitochondrial dynamics and bioenergetics in adult neurogenesis, a process that significantly influences cognitive function and brain plasticity. In this review, we examine the mechanisms by which mitochondria regulate adult neurogenesis, focusing on the impact of mitochondrial function on the behavior of neural stem/progenitor cells and the maturation and plasticity of newborn neurons in the adult mouse hippocampus. In addition, we explore the link between mitochondrial dysfunction, adult hippocampal neurogenesis and genes associated with cognitive deficits in neurodevelopmental disorders. In particular, we provide insights into how alterations in the transcriptional regulator NR2F1 affect mitochondrial dynamics and may contribute to the pathophysiology of the emerging neurodevelopmental disorder Bosch-Boonstra-Schaaf optic atrophy syndrome (BBSOAS). Understanding how genes involved in embryonic and adult neurogenesis affect mitochondrial function in neurological diseases might open new directions for therapeutic interventions aimed at boosting mitochondrial function during postnatal life.

Abstract Chemokine heterodimers activate or dampen their cognate receptors during inflammation. The CXCL12 chemokine forms with the fully reduced (fr) alarmin HMGB1 a physiologically relevant heterocomplex (frHMGB1•CXCL12) that synergically promotes the inflammatory response elicited by the G-protein coupled receptor CXCR4. The molecular details of complex formation were still elusive. Here we show by an integrated structural approach that frHMGB1•CXCL12 is a fuzzy heterocomplex. Unlike previous assumptions, frHMGB1 and CXCL12 form a dynamic equimolar assembly, with structured and unstructured frHMGB1 regions recognizing the CXCL12 dimerization surface. We uncover an unexpected role of the acidic intrinsically disordered region (IDR) of HMGB1 in heterocomplex formation and its binding to CXCR4 on the cell surface. Our work shows that the interaction of frHMGB1 with CXCL12 diverges from the classical rigid heterophilic chemokines dimerization. Simultaneous interference with multiple interactions within frHMGB1•CXCL12 might offer pharmacological strategies against inflammatory conditions.

BackgroundEvidence on the health impacts of social conditions has led US healthcare systems to consider identifying and addressing social adversity-e.g. food, housing, and transportation insecurity-in care delivery settings. Social screening is one strategy being used to gather patient information about social circumstances at the point of care. While several recent studies describe the rapid proliferation of social screening activities, little work has explored either why or how to implement social screening in clinical settings. Our study objectives were to assess diverse healthcare stakeholder perspectives on both the rationale for social screening and evidence needed to inform practice and policy-relevant implementation decisions.MethodsWe convened five focus groups with US experts representing different stakeholder groups: patient advocates, community-based organizations, healthcare professionals, payers, and policymakers. In total, 39 experts participated in approximately 90-minute long focus groups conducted between January-March 2021. A inductive thematic analysis approach was used to analyze discussions.ResultsThree themes emerged from focus groups, each reflecting the tension between the national enthusiasm for screening and existing evidence on the effectiveness and implementation of screening in clinical settings: (1) ambiguity about the rationale for social screening; (2) concerns about the relavence of screening tools and approaches, particularly for historically marginalized populations; (3) lack of clarity around the resources needed for implementation and scaling.ConclusionWhile participants across groups described potential benefits of social screening, they also highlighted knowledge gaps that interfered with realizing these benefits. Efforts to minimize and ideally resolve these knowledge gaps will advance future social screening practice and policy.

Cancer treatment can trigger or exacerbate health-related socioeconomic risks (HRSR; food/housing insecurity, transportation/utilities difficulties, and interpersonal violence). The American Cancer Society and National Cancer Institute recommend HRSR screening and referral, but little research has examined the perceptions of patients with cancer on the appropriateness of HRSR screening in healthcare settings. We examined whether HRSR status, desire for assistance with HRSRs, and sociodemographic and health care-related factors were associated with perceived appropriateness of HRSR screening in health care settings and comfort with HRSR documentation in electronic health records (EHR). A convenience sample of adult patients with cancer at two outpatient clinics completed self-administered surveys. We used χ 2 and Fisher exact tests to test for significant associations. The sample included 154 patients (72% female, 90% ages 45 years or older). Thirty-six percent reported ≥1 HRSRs and 27% desired assistance with HRSRs. Overall, 80% thought it was appropriate to assess for HRSRs in health care settings. The distributions of HRSR status and sociodemographic characteristics were similar among people who perceived screening to be appropriate and those who did not. Participants who perceived screening as appropriate were three times as likely to report prior experience with HRSR screening (31% vs. 10%, P = 0.01). Moreover, 60% felt comfortable having HRSRs documented in the EHR. Comfort with EHR documentation of HRSRs was significantly higher among patients desiring assistance with HRSRs (78%) compared with those who did not (53%, P < 0.01). While initiatives for HRSR screening are likely to be seen by patients with cancer as appropriate, concerns may remain over electronic documentation of HRSRs.SignificanceNational organizations recommend addressing HRSRs such as food/housing insecurity, transportation/utilities difficulties, and interpersonal violence among patients with cancer. In our study, most patients with cancer perceived screening for HRSRs in clinical settings as appropriate. Meanwhile, concerns may remain over the documentation of HRSRs in EHRs.

In the original analysis by Dalba et al. (2021) to confirm and characterize the Kepler-1704 system, an erroneous offset of 0.53878357713256 day was accidentally subtracted from the time stamps of the photometric measurements of this star acquired by the Kepler spacecraft. This photometry was then used in the comprehensive system modeling that yielded the final ephemeris of this exoplanet. As a result, parameters describing the timing of this planet’s orbit, most notably its conjunction (transit) time, were erroneously offset. This erratum serves to correct this error and the ephemeris of Kepler-1704 b. We added the 0.53878357713256 day offset to the time stamps of the Kepler photometry that was used in the original analysis. The corresponding flux values were unchanged. Besides the time stamps, we did not alter any other data product. We then conducted the joint modeling of the stellar and planetary parameters of the Kepler-1704 system using EXOFASTv2 (Eastman et al. 2019) exactly as described in Section 3 of Dalba et al. (2021). All priors and EXOFASTv2 settings were left as described in the original analysis. This new fit converged following the same criteria applied in the original analysis. We again observed a bimodality in mass and age of Kepler-1704 as described in Section 3.1 of Dalba et al. (2021). We selected the lower stellar mass solution just as before and calculated the updated stellar and planetary parameters, which are listed in Tables 1 and 2, respectively. The only parameter values in Tables 1 and 2 that changed significantly between Dalba et al. (2021) and this analysis are conjunction time (TC), periastron time (TP), and eclipse time (TS). This is expected given that the only change to the inputs to the EXOFASTv2 fit were the time stamps of the Kepler photometry. Changes for other parameters other than those listed above were only due to rounding error or small statistical variations in the Markov chain Monte Carlo analysis, and were all well within the 1σ uncertainties. Figure 1 shows the Kepler light curves with the updated time stamps and the updated best-fit models. This figure is analogous to Figure 5 of Dalba et al. (2021). Table 3 shows the updated predictions for the timing of future transits and periastron passages. Asexpected, the time of these events are shifted forward by the value of the time stamp offset relative to the corresponding times published in Table 4 of Dalba et al. (2021). We conducted two consistency checks of the new ephemeris for Kepler-1704 b. First, we accessed the Kepler Pre-search Data Conditioning Simple Aperture Photometry (PDCSAP; Jenkins et al. 2010; Smith et al. 2012; Stumpe et al. 2012) photometry of Kepler-1704 from Quarters 2 and 13 via the Mikulski Archive for Space Telescopes but we did not conduct any additional detrending. We inserted the unaltered PDCSAP transit light curves into the exact same EXOFASTv2 fit, which proceeded until convergence. The resulting orbital elements are consistent this with those listed in Table 2. Second, we accessed the Transit and Ephemeris Service on the NASA Exoplanet Archive15 and predicted future transit times of Kepler-1704 b using the planet candidate solution from the Kepler Quarter 1–17 Data Release 25 Supplemental Kepler Object of Interest Table. The resulting transit times forthe four events spanning the years 2023–2031 agreed with the transit times listed in Table 3 to within 1 minute.

INTRODUCTION: There is limited understanding of the pathomechanistic relationship between leptomeningeal collateral formation and ischaemic stroke aetiology. We aimed to assess the association of leptomeningeal collateral status and ischaemic stroke aetiology, using the widely recognised “Trial of Org 10172 in Acute Stroke Treatment” (TOAST) classification categorising strokes into five distinct aetiologies. METHODS: Retrospective study of consecutively admitted adult ischaemic stroke patients at a Swiss stroke centre. Leptomeningeal collateral status was assessed on admission with single-phase CT-angiographies using a validated 4-point score. Patients were categorised into large-artery atherosclerosis (LAA), cardioembolic (CE), small-vessel disease (SVD) and cryptogenic (CG) according to the TOAST classification. We performed ordinal and binary (poor [collaterals filling ≤50% of the occluded territory] vs good [collaterals filling >50% of the occluded territory] collateralisation) logistic regression to evaluate the impact of TOAST aetiology on collateral status. RESULTS: Among 191 patients, LAA patients had better collateral status compared to non-LAA aetiology (LAA: 2 vs CE: 2 vs SVD: 3 vs CG: 2, pLAA vs non-LAA = 0.04). In weighted multivariate logistic regression, LAA and SVD independently predicted better collateral status (binary models [adjusted odds ratio; aOR]: LAA: 3.72 [1.21–11.44] and SVD: 4.19 [1.21–14.52]; ordinal models [adjusted common odds ratio; acOR]: LAA: 2.26 [95% CI: 1.23–4.15] and SVD: 1.94 [1.03–3.66]), while CE predicted worse collateral status (binary models [aOR]: CE: 0.17 [0.07–0.41]; ordinal models [acOR]: CE: 0.24 [0.11–0.51]). CONCLUSION: The aetiology of ischaemic stroke is associated with leptomeningeal collateral status on single-phase CT-angiography, with LAA and SVD predicting better and CE predicting worse collateral status.

IntroductionThe COVID-19 pandemic led to a dramatic increase in telemedicine use for direct patient care. Inequities in device/internet access can limit the extent to which patients can engage with telemedicine care and exacerbate health disparities. In this review, we examined existing literature on interventions designed to improve patient telemedicine access by providing digital devices including tablets, smartphones, and computers and/or internet connectivity.MethodsIn this systematic scoping review, we searched four databases for peer-reviewed studies published 1/1/2000–10/19/2021 that described healthcare interventions that provided patients with devices and/or internet connectivity and reported outcomes related to telemedicine access and/or usage. Data extraction elements included: study population, setting, intervention design, details on device/connectivity provision, and outcomes evaluated.ResultsTwelve articles reflecting seven unique interventions met inclusion criteria. Ten articles examined telemedicine utilization (83%) and reported improved patient show rates/utilization. Seven articles examined patient satisfaction with the interventions (58%) and reported positive experiences. Fewer articles examined health outcomes (17%; 2/12) though these also demonstrated positive results. Across included studies, study quality was low. There were no controlled trials, and the most rigorously designed studies (n = 4) involved pre/post-intervention assessments.DiscussionFindings from this review indicate that providing material technology supports to patients can facilitate telemedicine access, is acceptable to patients and clinicians, and can contribute to improved health outcomes. The low number and quality of existing studies limits the strength of this evidence. Future research should explore interventions that can increase equitable access to telemedicine services.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=183442, identifier, PROSPERO: CRD42020183442.

Digital health has the potential to expand health care and improve outcomes for patients—particularly for those with challenges to accessing in-person care. The acceleration of digital health (and particularly telemedicine) prompted by the Coronavirus-19 (COVID-19) pandemic facilitated continuity of care in some settings but left many health systems ill-prepared to address digital uptake among patients from underserved backgrounds, who already experience health disparities. As use of digital health grows and the digital divide threatens to widen, healthcare systems must develop approaches to evaluate patients’ needs for digital health inclusion, and consequentially equip patients with the resources needed to access the benefits of digital health. However, this is particularly challenging given the absence of any standardized, validated multilingual screening instrument to assess patients’ readiness for digital healthcare that is feasible to administer in already under-resourced health systems. This perspective is structured as follows: (1) the need for digital health exclusion risk screening, (2) our convening as a group of stakeholders, (3) our review of the known digital health screening tools and our assessment, (4) formative work with patients regarding their perceptions on language and concepts in the digital health screening tools, and (5) conclusion with recommendations for digital health advocates generated by this collaborative of digital health researchers and operations leaders. There is a need to develop a brief, effective tool to screen for digital health use that can be widely implemented in diverse populations. We include lessons learned from our experiences in developing and testing risk of digital health exclusion screening questions in our respective health systems (e.g., patient perception of questions and response options). Because we recognize that health systems across the country may be facing similar challenges and questions, this perspective aims to inform ongoing efforts in developing health system digital exclusion screening tools and advocate for their role in advancing digital health equity.

Introduction: Ataxia is a neurological symptom that causes decreased balance, loss of coordination, and gait alterations. Innovative rehabilitation devices like virtual reality (VR) systems can provide task-oriented, repetitive and intensive training with multisensorial feedback, thus promoting neuroplastic processes. Among these VR technologies, the Computer Assisted Rehabilitation ENvironment (CAREN) associates a split belt treadmill on a 6-degrees of freedom platform with a 180° VR screen and a Vicon motion capture system to monitor patients’ movements during training sessions.Methods: Eight patients affected by cerebellar ataxia were enrolled and received 20 sessions of CAREN training in addition to standard rehabilitation treatment. Each patient was evaluated at the beginning and at the end of the study with 3D gait analysis and clinical scales to assess balance, gait function and risk of falls.Results: We found improvements in kinematic, kinetic, and electromyographic parameters (as per pre-post- CAREN training), as well as in clinical outcomes, such as balance and risk of falls in ataxic patients. In addition, we found that trunk rotation improved, after CAREN intervention, approximating to the normative values.Discussion: Our results suggested that CAREN might be useful to improve specific biomechanical parameters of gait in ataxic patients.

One of the main topics of mathematics education nowadays is teaching applications of mathematics in various fields, which lead in the recent decades to the development of the STEM education (Science, Technology, Engineering, and Mathematics), connecting these disciplines using transdisciplinary or interdisciplinary approaches. Applications of mathematics has become important not only from academic point of view, as helping students to understand mathematics, to apply mathematical knowledge in various contexts, and to show the utility of mathematics, but also because mathematics is an integral part of our daily lives. Teachers have an important role in this approach, so it is important to study their attitude towards teaching applications of mathematics and their experience. The research was conducted in 2021 in Israel. The participants are 221 mathematics teachers from post primary schools. The research instrument was a questionnaire developed for this study based on the scientific literature and aimed to find out teachers' opinion about teaching applications of mathematics and their practice in integrating applications in their teaching. The questionnaire contains both closed and open questions. The responses were quantitatively and qualitatively analyzed. The results of the study show that 42.5% of teachers in Israel are teaching applications of mathematics. Analyzing the answers given by those teachers, who teach applications of mathematics, 47% are teaching applications in physics, 47.5% integrate them in their lessons few times a semester, and 52.1% of them teaching applications through presenting it to the students. In the participants' opinion, the most important benefits of teaching applications of mathematics are arising students' interest for mathematics (44.3%) and motivating students for learning mathematics (34.8%). The most important obstacles of teaching applications of mathematics are time-constrains (30.8%) and lack of teachers' skills to teaching mathematical applications in other disciplines (24.6%).